|
| Reference | Type of transplant | Indication of FOS | Time to nephropathy after FOS initiation | Peak serum creatinine | Proteinuria | Biopsy results | Outcome |
|
| [8, 9] | Kidney
D+/R− | CMV syndrome
Persistent high CMV viremia after 65 days of GCV | 30 days (single treatment) | 387 μmol/L | 7 g/d | Birefringent crystal precipitation surrounded by macrophages in glomeruli and tubules. Fibrinoid thrombi.
Black crystals with Von Kossa’s reaction. | FOS withdrawn after 27 days.
Seven months after FOS nephropathy: creatinine level at 158 μmol/L, proteinuria at 2 g/d.
Second transplant biopsy: moderate interstitial fibrosis and tubular atrophy with sclerosis of half glomeruli, no crystal, and positive in situ CMV PCR. |
|
| [10] | Lung
D−/R+ | CMV bronchiolitis
M460I mutation in the UL97 gene | 35 days (second treatment; first treatment of 4 weeks) | 475 μmol/L | NR | Autopsy: birefringent short crystals with angular edges in glomeruli (with rupture of capillaries and Bowman’s capsule) and in tubules with tubular necrosis and granulomas. | No FOS withdrawal.
Death 5.5 months after CMV disease (mild acute rejection, chronic lung rejection).
Crystals found in lungs, esophagus, kidney, epicardium, pericardium, and tricuspid valve at autopsy. |
|
| [11] | Kidney
D−/R+ | Asymptomatic reactivation of GCV resistant strain despite prophylactic valganciclovir | 21 days (single treatment) | Anuria, hemodialysis | NR | Crystals in tubules and in one-third of glomeruli with rupture of the basement membrane, tubular necrosis, and macrophages. | Multiorgan (kidney, pancreas, and myocardium) damage due to FOS crystal precipitation.
Pancreatitis and myocarditis resolved.
Graft loss and dialysis therapy continued. |
|
| [12] | Kidney
D+/R− | CMV hepatitis and retinitis
A594V mutation in the UL97 gene | After 14 days (single treatment) | 157 μmol/L | NR | Birefringent crystals in the tubular lumens.
Black crystals with Von Kossa’s reaction. | FOS withdrawal.
Ten months after FOS nephropathy: creatinine level at 112 μmol/L.
Second transplant biopsy: disappearance of crystal deposition. |
|
| PR | Kidney
D+/R− | CMV gastritis
A594V and L595S mutations in the UL97 gene | 6 days (second treatment; first treatment of 14 days) | 450 μmol/L | 4.5 g/g of creatininuria | Crystals in glomeruli and tubules. | FOS withdrawal followed by Brincidofovir.
Second biopsy: disappearance of crystals, sclerosis of one-third glomeruli, mild interstitial fibrosis, and tubular atrophy.
Third treatment with FOS: resolution of CMV disease.
One year after FOS nephropathy: creatinine level at 130 μmol/L, proteinuria at 0.6 g/g. |
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